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Characteristics of in-hospital cardiac arrest and cardiopulmonary resuscitation  [PDF]
Tomislav Ru?man,Dubravka Ivi?,Vi?nja Iki?,Josip Ivi?
Medicinski Glasnik , 2009,
Abstract: Aim We have studied epidemiology of in-hospital cardiac arrest, characteristics of organizing a reanimationand its,procedures as well as its documenting.Methods We analyzed all resuscitation procedure data where anesthesiology reanimation teams (RT) providedcardiopulmonary resuscitation (CPR) during one-year period. We included resuscitation attemptsthat were initiated outside the Department of Anesthesiology, excluding incidents in operation rooms andIntensive Care Unit (ICU). Data on every cardiac arrest and CPR were entered in a special form.Results During one-year period 87 CPR were performed. Victims of cardiac arrest were principallyelderly patients (age 60 – 80), mostly male (60%). Most frequent victims were neurological patients(42%), surgical patients (21%) and neurosurgical patients (10%). The leading cause of cardiac arrestwas primary heart disease, following neurological diseases and respiration disorders of severe etiology.In over 90% cases CPR was initiated by medical personnel in their respective departments, RT arrivedwithin 5 minutes in 73,56% cases. Initially survival was 32%, but full recovery was accomplished in 4patients out of 87 (4,6%).Conclusion Victims of cardiac arrest are patients whose primary disease contributes to occurrence ofcardiorespiratory complications. High mortality and low percentage of full recovery can be explainedby characteristics of patients (old age, nature and seriousness of primary disease) which significantly affectthe outcome of CPR. In some cases a question is raised whether to initiate the CPR at all. We wouldlike to point out that continous monitoring of potentially critical patients may prevent cardiorespiratoryincidents whereas the quality and success of CPR may be improved by training of staff and better technicalequipment on the relevant locations in the in the hospital where such incidents usually occur.
Year in review 2010: Critical Care - cardiac arrest and cardiopulmonary resuscitation
Jeffery C Metzger, Alexander L Eastman, Paul E Pepe
Critical Care , 2011, DOI: 10.1186/cc10540
Abstract: In 2010, a number of papers were published in the field of cardiac arrest and cardiopulmonary resuscitation (CPR). Critical Care provided us with some innovative and important data within these fields of research. This review will summarize some of the notable data published in 2010 and focus on papers published in Critical Care. For example, we discuss the latest research in therapeutic hypothermia after cardiac arrest and also review the effects of bystander-initiated cardiopulmonary resuscitation (BCPR), the role of hypercapnea in near-death experiences (NDEs) during cardiac arrest, markers of endothelial injury after CPR, and the use of cell-free plasma DNA as a marker to predict outcome after CPR.While the idea of therapeutic hypothermia is not new by any means (dating back to its recommended use by Hippocrates for wounded patients [1]), therapeutic hypothermia has been shown for almost a decade to decrease mortality and improve outcomes after cardiac arrest [2,3]. In 2010, we continued to learn about this life-saving therapeutic modality.Several studies looked at the mechanisms of cooling patients. One study looked at the use of an external shower of water (2°C) which achieved a median rate of cooling of 3°C per hour [4]. Another study showed that the Arctic Sun device (Medivance, Inc., Louisville, CO, USA) cooled, on average, 54 minutes faster than other external measures such as ice packets and blankets [5], whereas yet another study [6] compared endovascular cooling with external cooling and showed that endovascular cooling led to more time in the target temperature range, less temperature fluctuation, and more control during rewarming. It is currently recommended that cooling be achieved as soon as possible [6]. In a study in Critical Care, ?kulec and colleagues [7] looked at the effectiveness of infusing 15 to 20 mL/kg of 4°C saline intravenously in the pre-hospital environment and found an average decrease in the tympanic temperature of 1.4°C over the co
Therapeutic Hypothermia Activates the Endothelin and Nitric Oxide Systems after Cardiac Arrest in a Pig Model of Cardiopulmonary Resuscitation  [PDF]
Frank Zoerner, Lars Wiklund, Adriana Miclescu, Cecile Martijn
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0064792
Abstract: Post-cardiac arrest myocardial dysfunction is a major cause of mortality in patients receiving successful cardiopulmonary resuscitation (CPR). Mild therapeutic hypothermia (MTH) is the recommended treatment after resuscitation from cardiac arrest (CA) and is known to exert neuroprotective effects and improve short-term survival. Yet its cytoprotective mechanisms are not fully understood. In this study, our aim was to determine the possible effect of MTH on vasoactive mediators belonging to the endothelin/nitric oxide axis in our porcine model of CA and CPR. Pigs underwent either untreated CA or CA with subsequent CPR. After state-of-the-art resuscitation, the animals were either left untreated, cooled between 32–34°C after ROSC or treated with a bolus injection of S-PBN (sodium 4-[(tert-butylimino) methyl]benzene-3-sulfonate N-oxide) until 180 min after ROSC, respectively. The expression of endothelin 1 (ET-1), endothelin converting enzyme 1 (ECE-1), and endothelin A and B receptors (ETAR and ETBR) transcripts were measured using quantitative real-time PCR while protein levels for the ETAR, ETBR and nitric oxide synthases (NOS) were assessed using immunohistochemistry and Western Blot. Our results indicated that the endothelin system was not upregulated at 30, 60 and 180 min after ROSC in untreated postcardiac arrest syndrome. Post-resuscitative 3 hour-long treatments either with MTH or S-PBN stimulated ET-1, ECE-1, ETAR and ETBR as well as neuronal NOS and endothelial NOS in left ventricular cardiomyocytes. Our data suggests that the endothelin and nitric oxide pathways are activated by MTH in the heart.
Estrogen-Mediated Renoprotection following Cardiac Arrest and Cardiopulmonary Resuscitation Is Robust to GPR30 Gene Deletion  [PDF]
Michael P. Hutchens, Yasuharu Kosaka, Wenri Zhang, Tetsuhiro Fujiyoshi, Stephanie Murphy, Nabil Alkayed, Sharon Anderson
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099910
Abstract: Introduction Acute kidney injury is a serious,sexually dimorphic perioperative complication, primarily attributed to hypoperfusion. We previously found that estradiol is renoprotective after cardiac arrest and cardiopulmonary resuscitation in ovariectomized female mice. Additionally, we found that neither estrogen receptor alpha nor beta mediated this effect. We hypothesized that the G protein estrogen receptor (GPR30) mediates the renoprotective effect of estrogen. Methods Ovariectomized female and gonadally intact male wild-type and GPR30 gene-deleted mice were treated with either vehicle or 17β-estradiol for 7 days, then subjected to cardiac arrest and cardiopulmonary resuscitation. Twenty four hours later, serum creatinine and urea nitrogen were measured, and histologic renal injury was evaluated by unbiased stereology. Results In both males and females, GPR30 gene deletion was associated with reduced serum creatinine regardless of treatment. Estrogen treatment of GPR30 gene-deleted males and females was associated with increased preprocedural weight. In ovariectomized female mice, estrogen treatment did not alter resuscitation, but was renoprotective regardless of GPR30 gene deletion. In males, estrogen reduced the time-to-resuscitate and epinephrine required. In wild-type male mice, serum creatinine was reduced, but neither serum urea nitrogen nor histologic outcomes were affected by estrogen treatment. In GPR30 gene-deleted males, estrogen did not alter renal outcomes. Similarly, renal injury was not affected by G1 therapy of ovariectomized female wild-type mice. Conclusion Treatment with 17β-estradiol is renoprotective after whole-body ischemia-reperfusion in ovariectomized female mice irrespective of GPR30 gene deletion. Treatment with the GPR30 agonist G1 did not alter renal outcome in females. We conclude GPR30 does not mediate the renoprotective effect of estrogen in ovariectomized female mice. In males, estrogen therapy was not renoprotective. Estrogen treatment of GPR30 gene-deleted mice was associated with increased preprocedural weight in both sexes. Of significance to further investigation, GPR30 gene deletion was associated with reduced serum creatinine, regardless of treatment.
Targeting out-of-hospital cardiac arrest: the effect of heparin administered during cardiopulmonary resuscitation (T-ARREST)  [cached]
Signa Vitae , 2011,
Abstract: Introduction. Heparin administration during cardiopulmonary resuscitation (CPR) may prevent activation of coagulation after successful resuscitation for out-of-hospital cardiac arrest (OHCA). We hypothesize that such an approach is not associated with an increased rate of bleeding, but it has not been evaluated. We performed a pilot randomized clinical study assessing the safety of intra-arrest heparin administration in OHCA patients with suspected acute myocardial infarction (AMI) and its impact on their prognosis. Materials and Methods. OHCA patients were randomized during CPR to 10 000 units of intra-arrest intravenous heparin (Group H) or to treatment without heparin (Group C). The occurrence of major bleeding and the presence of a favourable neurological result 3 months after OHCA, were analyzed. Results. Out of 88 randomized patients, AMI was subsequently confirmed in 63 of them (71.6 %). There were 30 patients in group H and 33 in group C. No major bleeding event was observed in either group. Return of spontaneous circulation (ROSC, Group H: 40.0%, Group C: 45.4%, p=0.662) and a good neurological result 3 months after OHCA (Group H: 6.7 %, Group C: 9.1 %, p=0.921) did not differ between groups. Conclusions. Intravenous administration of 10 000 units of heparin during CPR for OHCA in patients with supposed AMI was safe. We did not find any improvement in prognosis for our sample of limited size. Though the procedure proved safe, we recommend postponing the administration of heparin until ROSC, assessment of clinical state and recording of a twelve-lead ECG.
Theoretical knowledge of nurses working in non-hospital urgent and emergency care units concerning cardiopulmonary arrest and resuscitation
Almeida, Angélica Olivetto de;Araújo, Izilda Esmenia Muglia;Dalri, Maria Célia Barcellos;Araujo, Sebasti?o;
Revista Latino-Americana de Enfermagem , 2011, DOI: 10.1590/S0104-11692011000200006
Abstract: non-hospital urgent and emergency care units were created to deliver care to patients in chronic or acute situations and to coordinate the flow of urgent care. this descriptive study analyzed the theoretical knowledge of nurses working in these units concerning cardiopulmonary arrest and resuscitation. a questionnaire was applied to 73 nurses from 16 units in seven cities in the region of campinas, sp, brazil. the respondents displayed some gaps in their knowledge such as how to detect cardiopulmonary arrest (cpa), the ability to list the sequence of basic life support, and how to determine the appropriate compression to ventilation ratio (>60%). they also did not know: the immediate procedures to take after cpa detection (>70%); the rhythm pattern present in a cpa (>80%); and they only partially identified (100%) the medication used in cardiopulmonary resuscitation. the average score on a scale from zero to ten was 5.2 (± 1.4). the nurses presented partial knowledge of the guidelines available in the literature.
Impact of Toll-Like Receptor 2 Deficiency on Survival and Neurological Function after Cardiac Arrest: A Murine Model of Cardiopulmonary Resuscitation  [PDF]
Stefan Bergt, Anne Güter, Andrea Grub, Nana-Maria Wagner, Claudia Beltschany, S?nke Langner, Andreas Wree, Steve Hildebrandt, Gabriele N?ldge-Schomburg, Brigitte Vollmar, Jan P. Roesner
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0074944
Abstract: Background Cardiac arrest (CA) followed by cardiopulmonary resuscitation (CPR) is associated with poor survival rate and neurofunctional outcome. Toll-like receptor 2 (TLR2) plays an important role in conditions of sterile inflammation such as reperfusion injury. Recent data demonstrated beneficial effects of the administration of TLR2-blocking antibodies in ischemia/reperfusion injury. In this study we investigated the role of TLR2 for survival and neurofunctional outcome after CA/CPR in mice. Methods Female TLR2-deficient (TLR2-/-) and wild type (WT) mice were subjected to CA for eight min induced by intravenous injection of potassium chloride and CPR by external chest compression. Upon the beginning of CPR, n?=?15 WT mice received 5 μg/g T2.5 TLR2 inhibiting antibody intravenously while n?=?30 TLR2-/- and n?=?31?WT controls were subjected to injection of normal saline. Survival and neurological outcome were evaluated during a 28-day follow up period. Basic neurological function, balance, coordination and overall motor function as well as spatial learning and memory were investigated, respectively. In a separate set of experiments, six mice per group were analysed for cytokine and corticosterone serum levels eight hours after CA/CPR. Results TLR2 deficiency and treatment with a TLR2 blocking antibody were associated with increased survival (77% and 80% vs. 51% of WT control; both P?<?0.05). Neurofunctional performance was less compromised in TLR2-/- and antibody treated mice. Compared to WT and antibody treated mice, TLR2-/-?mice exhibited reduced IL-6 (both P?<?0.05) but not IL-1β levels and increased corticosterone plasma concentrations (both P?<?0.05). Conclusion Deficiency or functional blockade of TLR2 is associated with increased survival and improved neurofunctional outcome in a mouse model of CA/CPR. Thus, TLR2 inhibition could provide a novel therapeutic approach for reducing mortality and morbidity after cardiac arrest and cardiopulmonary resuscitation.
Improving outcome in out-of-hospital cardiac arrest: impact of bystander cardiopulmonary resuscitation and prehospital physician care
Robert JH Jackson, Jerry P Nolan
Critical Care , 2011, DOI: 10.1186/cc9356
Abstract: Yasunaga and co-workers have used the nationwide registry of out-of-hospital cardiac arrest patients in Japan to evaluate prospectively two key components of the chain of survival: early cardiopulmonary resuscitation (CPR) and early advanced cardiac life support (ACLS) [1]. Following out-of-hospital cardiac arrest, it is generally acknowledged that bystander CPR increases long-term survival rates by two to three times [2] and that each minute of delay before defibrillation reduces the probability of survival to discharge by 10 to 12% [3]. Whether or not ACLS interventions (such as drugs and tracheal intubation) affect outcome is much more contentious [4].The study compares the combined impact of bystander-initiated cardiopulmonary resuscitation (BCPR) and physician-delivered ACLS a€“ with BCPR emergency life-saving technician (ELST)-delivered ACLS. The potential interventions provided by physicians, but not the ELSTs, included: tracheal intubation, central venous catheterisation, and injection of lidocaine, atropine and vasoactive, anaesthetic and fibrinolytic drugs. Yasunaga and co-workers have compared the outcomes from four groups of patients following witnessed cardiac arrest: those who received ELST-delivered ACLS without (Group A) and with (Group B) BCPR, and those who received physician-delivered ACLS without (Group C) and with (Group D) BCPR.Consistent with previous studies, bystander CPR improved survival rates at 1 month by approximately 50% in both those patients receiving ELST-delivered ACLS and those who received physician-delivered ACLS.Previous studies have failed to show a survival benefit following implementation of ACLS in the out-of-hospital setting [4]. This study has demonstrated an increase in survival in all patient groups associated with the addition of physician-delivered ACLS. Worryingly, however, in the patients who did not receive bystander CPR, this increase in survival was due largely to an increase in patients surviving with severe neu
Cardiac arrest and cardiopulmonary resuscitation knowledge of nursing staff in a pediatric emergency service
Helen Concei??o Pereira Vendas Rodrigues, Tathiana Silva de Souza Martins, Renata Oliveira Maciel
Revista de Enfermagem UFPE On Line , 2010,
Abstract: Objective: to characterize the nursing team who works at the pediatric clinic of a university hospital (UH); reveal the knowledge of the nursing staff of the pediatric clinic of a UH, the episode about the cardiopulmonary arrest and resuscitation (CPA/CPR), to discuss the implications of such knowledge about the advent of CPA/CPR assistance to the child and implement a training program in service from the results identified. Method: descriptive exploratory study with a quantitative approach. Is the backdrop of the pediatric clinic of a HU. The study population will consist of all members of the nursing staff. The sample is all members of the nursing staff that meet the criteria for inclusion, ie, they should: work more than a year in the industry and sign the Consent Form. To collect the data using a questionnaire composed of variables related to the profile of the participants and their understanding of performance in CPA/CPR. Research approved by the Ethics Committee and Research of the University Hospital Pedro Ernesto (HUPE)/UERJ in number protocolo 2571. The data will be analyzed by simple statistics, and then discussed according to the literature and organized into categories.
Extensive colonic necrosis following cardiac arrest and successful cardiopulmonary resuscitation: report of a case and literature review  [cached]
Katsoulis Iraklis E,Balanika Alexia,Sakalidou Maria,Gogoulou Ioanna
World Journal of Emergency Surgery , 2012, DOI: 10.1186/1749-7922-7-35
Abstract: Non-occlusive colonic ischaemia is a recognized albeit rare entity related to low blood flow within the visceral circulation and in most reported cases the right colon was affected. This is the second case report in the literature of extensive colonic necrosis following cardiac arrest and cardiopulmonary resuscitation (CPR). A 83-year-old Caucasian woman was admitted to our hospital due to a low energy hip fracture. On her way to the radiology department she sustained a cardiac arrest. CPR started immediately and was successful. A few hours later, the patient developed increasing abdominal distension and severe metabolic acidocis. An abdominal multidetector computed tomography (MDCT) scan was suggestive of intestinal ischaemia. At laparotomy, the terminal ileum was ischaemic and extensive colonic necrosis was found, sparing only the proximal third of the transverse colon. The rectum was also spared. The terminal ileum and the entire colon were resected and an end ileostomy was fashioned. Although the patient exhibited a transient improvement during the immediate postoperative period, she eventually died 24h later from multiple organ failure. Histology showed transmural colonic necrosis with no evidence of a thromboembolic process or vasculitis. Therefore, this entity was attributed to a low flow state within the intestinal circulation secondary to the cardiac arrest.
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